CSA Online First

CSA Online First is a weekly blog featuring insights from CSA members themselves.

Edited by Rita Agarwal, MD, FAAP, with contributions from CSA’s Committee on Professional and Public Communications, Online First is a place where knowledge and opinion from any one of our 3200 plus physician-anesthesiologist members can be shared, discussed and deliberated to advance the specialty of anesthesiology, the practice of medicine and society in general.

"Better solutions to difficult problems are usually made when all sides are heard."

Steven Goldfien, MD

 

ASA Legislative Day

by
  • Doyle, Christine, MD, FASA
  • Hertzberg, Linda, MD, FASA
| May 29, 2019

Linda_HertzbergdoyleThe Annual ASA Washington Legislative conference brings together over 600 anesthesiologists from all over the country the week of May 13. California had fantastic representation with over 20 attendees including five residents.* We had a busy schedule and our work cut out for us!

ASA staff in the Washington office spend all year discussing issues of importance to our specialty with legislators.  But the impact that a group of physicians who take time away from their practices and patients, to come to speak to representatives and their staff, is invaluable.  That work continues after everyone gets home, with vital follow-up discussions with district staff.

ASA had several issues for us to bring to our legislators. These were:

  • Surprise Medical Bills, Out-of-Network Billing
  • Support for NIH Research for Brain Health in Older Patients
  • Medicare-Based Healthcare Reform Proposals Can’t Support Anesthesia Practices
  • Provide Loan Interest Relief to Medical Residents
  • Improve Rural Health Care Access

For some of these items, legislation had already been proposed, and for some were no current bills to reference.

The big issue this year, not surprisingly, revolved around what the politicians call ASA Leg Day 2019“surprise billing” — bills that are unexpected, typically because they are for out-of-network care.  Senators Cassidy (R-LA) and Hassan (D-NH) have proposed legislation to address this, based in part on the successful New York legislation that has brought physicians and payers closer together on contracting and payments, thus leading to a significant decrease in out-of-network bills.  New York reports that out of about 7 million claims in the past 2 years, only 1100 have gone to the mandated baseball style arbitration; the decisions have been about 50-50 for physicians vs payers.  ASA (and other specialty societies) continues to work with Senators Cassidy and Hassan and their staff to refine the language in the bill in order to protect both patients and physicians from unfair practices.

While we were in Washington, DC, the House Energy & Commerce (E&C) committee unexpectedly released another piece of draft legislation on the same topic, titled the “No Surprises Act”.  This is based loosely on California’s AB 72 legislation from two years ago. Practice Resource: Surprise Billing

As has been discussed in prior CSAOF blog posts, AB 72 has only widened the gap between physicians and payers. The Latest on Surprise Billing. It is clear from other articles posted online about the No Surprises Act, that this specific draft legislation has been driven by the payers. It likely to be opposed by the ASA in its current form.  

ASA Leg Day 2019 pic 2Medicare-For-All is also a hot topic on the Hill, but it was clear to everyone that, despite a great deal of enthusiasm and effort it is unlikely that there will be any bill that rises to the top and is enacted this year.  At last count there are seven bills on this general subject, and more are rumored to be in the works. Improved access to health care and coverage for its costs will continue be a major issue for Congress to address, likely after the 2020 elections.

The Resident Education Deferred Interact Act (the REDI Act), H.R. 1554, amends the Higher Education Act of 1965 to provide for interest-free deferment on student loans for borrowers serving in a medical or dental internship or residency program. It’s one of the shortest bills that we’ve ever seen — 16 lines including the title!  Currently, although loan payments may be deferred during residency, interest starts accruing as soon as one graduates from medical or dental school.  This bill stops that compounding of interest upon graduation and is estimated to provide average savings of $100,000 to residents on their student loan debt.  This complements other ideas from across the country to reduce student debt, including some medical schools’ proposals to eliminate tuition. The recent surprise promise made by billionaire Robert F. Smith during his Morehouse commencement address to pay off the entire Class of 2019’s student debts brought national attention to the student loan debt burden.

Together the members of the CSA delegation visited 33 Congressional and Senate ASA Lef Update pic 3offices while in Washington, DC despite missing a few members who were unable to attend.  Many thanks to those who stepped up to cover their appointments and to David Butler for keeping us all organized and on schedule.

If you aren’t able to take the time to travel to Washington, DC, there are other opportunities to visit with Congressional and Senate representatives within the district.  Meetings in the district are often more relaxed, with fewer distractions (no committee meetings, no votes, etc.).  If you are interested in participating, please reach out to any of the CSA leadership for a primer on legislative advocacy.

* Attending and representing California were, Johnathan Pregler, MD, Jeffrey Poage, MD, FASA, Samuel Wald, MD, MBA, FASA  Philip Levin, MD, FASA, Christine Doyle, MD, FASA, Sunny Jha, MD, Paul Yost, MD, FASA, Robin Seaberg, MD, Jennifer Butler Telesz, MD, Neal Cohen, MD, MPH, MS, Anita Gupta, DO, PharmD, MPP, FASA, and Linda Hertzberg, MD, FASA. Anesthesia residents attending were Murad Arif, MD, Reihaneh Forghany, MD, Jay Rajan, MD, Behrod Katebian, MD, and Adam Milam, MD.  ASA leadership from California included ASA President Linda Mason, MD, FASA, Michael Champeau, MD, FASA and James Grant, MD, MBA, FASA. CSA Executive Director David Butler and KP lobbyist Vanessa Cajina also attended.

 

 

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